Idaho hospital to stop obstetrical services, citing doc shortages, fewer births and 'political climate'

An Idaho hospital plans to close down its labor and delivery unit, forcing pregnant women in the area to drive at least 46 miles to the closest hospital or birthing centers.

Rural areas in the U.S. have faced a decline in hospitals that provide obstetric services for years. Thirty-six percent of U.S. counties had no hospital or birth center offering obstetrics care or any other obstetrics providers in 2020, representing a 2% increase in “maternity care deserts” from 2018, according to a report from March of Dimes. Seven million women across the country live in areas of limited or no access to maternity health care services.

Hospitals continue to shut down maternity wards at a rapid pace, citing changing demographics, lower birth rates and the high cost of operating obstetrical services.

Bonner General Health, a 25-bed hospital in Sandpoint, Idaho, also cited some of these factors in its decision to close its labor and delivery unit.

The number of deliveries at Bonner General Health has continued to decrease yearly, the hospital said in a news release (PDF) explaining its decision to stop delivering babies. "We delivered 265 babies in 2022 and admitted less than ten pediatric patients for other reasons. There are many reasons, including a nationwide decrease in births, an older population moving to Bonner County, and Kootenai Health having a new, updated unit with Neonatologists and OBs in-house24/7," hospital executives said.

The hospital also cited a shortage of pediatrician coverage, specifically to manage neonatal resuscitations and perinatal care. "BGH has reached out to other active and retired providers in the community requesting assistance with pediatric call coverage with no long-term sustainable solutions.Our low patient volume is insufficient to attract candidates for pediatric hospitalists, and we cannot afford to continue having locum tenens physicians," the hospital said.

But hospital leadership also pointed to Idaho's legal and political climate around healthcare, including punitive abortion bans that "criminalize physicians for medical care nationally recognized as the standard of care."

"Highly respected, talented physicians are leaving. Recruiting replacements will be extraordinarily difficult," hospital leadership said in the news release. "Consequences for Idaho physicians providing the standard of care may include civil litigation and criminal prosecution, leading to jail time or fines."

"We have made every effort to avoid eliminating these services," stated Ford Elsaesser, Bonner General Health's Board president. "We hoped to be the exception, but our challenges are impossible to overcome now."

Bonner General Health is the only hospital in Sandpoint, a city of more than 9,000 people, the Idaho Statesman reported.

The hospital said it would make every attempt to continue deliveries through May 19, but said it would depend on staffing. It will continue to provide women's health services at Sandpoint Women's Health and collaborate with Kootenai Health, about an hour away, to coordinate obstetrical care.

Idaho has one of the most restrictive abortion bans in the country. The law prohibits abortion at all stages of pregnancy, with exceptions for the life of the pregnant person and for survivors of rape and incest who have reported the incident to law enforcement.

Dorothy Moon, the state’s GOP chairwoman, criticized Bonner General Health’s assertion that Idaho’s political atmosphere contributed to its decision, according to reporting from the Washington Post. She said the true culprit was a mismanagement of resources, including an “inability to position the hospital to accommodate declining demographics," the WP reported.

“The real issue here is one facing all of rural America: the failure of large health care entities to provide financially affordable healthcare in a sustainable fashion,” Moon wrote in an email to The Washington Post. “This isn’t about abortion; it’s about making excuses for staffing issues.”

Amelia Huntsberger, M.D., an OB-GYN at Bonner General Health, told the Idaho Statesman in an email that she will soon leave the hospital and the state because of the abortion laws and the Legislature’s decision not to continue the state’s maternal mortality review committee.

Deborah Owen, M.D., an OB-GYN who lives in Sandpoint but does not practice medicine there, wrote in the Bonner County Daily Bee that the passage of Idaho’s “trigger laws” after the fall of Roe v. Wade would make recruitment of new Ob/Gyn physicians to Idaho "almost impossible going forward."

"The fallout from this is that Ob/Gyn physicians are quietly leaving the state. Most physicians don’t go into medicine because they want to have frequent contact with the legal profession. It’s easier to relocate than to live in fear or have to live with yourself when you are forbidden to use your skills and training to save or help a patient with a severely compromised pregnancy," Owen wrote.

Just in 2023 alone, a number of hospitals have announced plans to shut down labor and delivery care as they look to cut unprofitable business lines. The scaling back and closing of obstetrics units only widens maternity care deserts throughout the country. 

Astria Toppenish Hospital in Washington state closed its maternity center in January, citing financial losses, fewer deliveries and reduced Medicaid funding as reasons for the decision. 

Ascension St. Vincent's Riverside in Jacksonville, Florida, will be ending maternity care at the hospital later this year, affecting 68 jobs, Becker's Hospital Review reported, citing a Workforce Adjustment and Retraining Notification filed with the state. The hospital attributed this decision to declining maternity patient volumes at the hospital and the increasing availability of alternative regional sites to provide maternity care.

Becker's also reported in June that 11 hospitals and health systems have announced the permanent or temporary closure of obstetric services since March 2022.

Memorial Hospital in Carthage, Illinois, Lincoln Memorial, also in Illinois and Greenwood Leflore Hospital in the Mississippi Delta also closed down their labor and delivery units in the past six months, as Axios reported.

An absence of obstetric care is significantly associated with increased preterm births and more births in facilities that lack staff trained in labor and delivery, according to a 2018 study published in the Journal of the American Medical Association.

Many healthcare leaders say strict abortion bans put physicians in a position to make difficult judgment calls about which cases qualify as a medical exception while facing the risk of lawsuits, loss of their medical licenses and possible incarceration.

Most doctors are confused about what constitutes a "life-saving emergency" to overrule state abortion bans, a Sermo survey found. And 79% of physicians are concerned that doctors are being asked to wait until the “very last minute when it’s clear a patient will die” before performing an abortion. Alarmingly, over two-thirds of those surveyed said they expect more maternal deaths in states where abortion is banned.

In Texas, five women and two OB-GYNs are suing the state over its abortion bans, claiming the laws have created so much fear among providers that pregnant women have been denied necessary and potentially lifesaving obstetrical care.